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Hi All

Female patient not childbearing age with historical A POS no antibodies detected subsequently multi transfused.

After transfusion of 2 x O NEG units a week later a sample tested no antibodies detected by IAT however cross-match request was performed by IAT and both units were positive

Further testing

DAT +1 and panel cells enzyme ONLY reactive +2 with R1R1 cells and the rest of the panel cell reactions +4

ABO reverse grouping showed A cells +2 (conclusion therefore possible A subtype with a no specific antibody or reaction with cde in reverse grouping reagents due to an anti-c)

Reference Lab Results 

Non specific anti-E and anti-c detected in enzyme IAT, DAT IgG 1+

As multi transfusion advise was cross-matching group O E-c-K- red cells

Genotyping results to follow.

 

Would anyone agree with the reactions with the reverse grouping agents and if they have seen this was the anti-c detected been by IAT/and or Enzyme  

 

Thanks

 

 

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Was elution done? Anti-c may be IgM!

(we do see this when reverse cells giving discrepancy due to (mostly) cells being M+/Lea+/Leb+ , some time c+.

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The reverse grouping red cells in the UK often react with an anti-c.

I would be happy (on the evidence you give) to transfuse c-, E-, K- cross-match compatible blood.

As you KNOW that the patient is group A, I would ignore the bit about giving group O blood, which is totally over the top.

 

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9 hours ago, Eagle Eye said:

Was elution done? Anti-c may be IgM!

(we do see this when reverse cells giving discrepancy due to (mostly) cells being M+/Lea+/Leb+ , some time c+.

Interesting about Lea+Leb+. The eluate was negative 

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Final results ABO group not determined.

Phenotype c-E-K-M+N- and interestingly Fy GATA mutation negative. 

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Patient phenotype is Fya + Fyb+

I just had not seen a Gata mutation result before had read about it. Thought it may be an additional molecular phenotype request but it was included in the panel reported

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Posted (edited)

Thanks for that Tabbie - that puts my mind at rest.

There is NO shame whatsoever of not having come across this before.  Kudos to you for 1. admitting it (a whole lot of people would not have done) and 2. kudos to you for reading about it.

I would just suggest, however, that you start off on the right foot by calling it the GATA-1 mutation (and it has to be homozygous (sorry, I'm a pedant about corect terminology)!

Edited by Malcolm Needs

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I must be misunderstanding - the initial workup showed that there was 2+ reactivity with R1R1 cells  and anti-c was identified.  I thought R1R1 cells would be c negative and am not understanding the designation "non specific anti-E and anti-c".  This isn't a term that I am familiar with.

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17 minutes ago, applejw said:

I must be misunderstanding - the initial workup showed that there was 2+ reactivity with R1R1 cells  and anti-c was identified.  I thought R1R1 cells would be c negative and am not understanding the designation "non specific anti-E and anti-c".  This isn't a term that I am familiar with.

Unfortunately, NHSBT RCI reports now use "coded comments", rather than free text.  The "coded comments" are, almost universally, ungrammatical, reflect poor scientific (in particular, blood group) nomenclature, are frequently clinically inaccurate and are totally confusing, so I am not surprised you are not familiar with the term, because, in reality, it shouldn't exist, especially in a report from a Reference Laboratory.

The reason "canned comments" are used are two-fold.  Firstly, they can be put in quickly (striking one key can put in a complete sentence - although, as I said above, most of them are far from grammatically correct sentences - and, of course, hit the wrong key, and you have a comment that is even less relevant than hitting the correct key), so this is "LEAN".  Secondly, and much more insulting, is that one of the senior managers thinks that, if a CORRECT free text report is provided, the poor souls who work in a hospital laboratory will not be able to understand it.  How would you feel about that applejw?

Of course, in this case, there is probably an auto-antibody, directed against an antigen within the Rh Blood Group System, such as anti-Rh17 or anti-Rh18, that mimics more "common" Rh antibody specificities, such as anti-c and anti-E.  In this case, the antibody reacts with all antibody panel cells, but reacts more strongly with those cells expressing the c and the E antigen, hence the inaccurate, and scientifically poor (appalling) comment about "non-specific anti-E and anti-c".

I hope you are sufficiently intelligent to understand this.

THAT LAST SENTENCE IS MEANT AS A JOKE (although, not necessarily, if the person reading this happens to be the senior NHSBT manager who thinks hospital staff are thick)!

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